Acute diverticulitis is a condition in which one or more small, bulging sacs or pockets (diverticula) in the wall of the large intestine become inflamed or infected. There are several surgical options available to treat acute diverticulitis, depending on the severity of the condition and other individual factors. As always, consult with your doctor about the info you find on any site; they should be the one helping you make decisions. We want to ensure we can provide you with as much knowledge and information as possible so that you have a truly productive conversation with you doctor.
That being said, Here are the most common types of surgery related to acute diverticulitis:
Drainage procedures: In some cases, a minimally invasive procedure known as percutaneous drainage may be used to treat acute diverticulitis. This procedure involves draining the infected or inflamed tissue through a small incision in the skin.
The main benefit of drainage procedures is that they can provide rapid relief of symptoms by draining the infected or inflamed tissue. These procedures are often performed on an outpatient basis, meaning the patient can return home the same day.
Diverticulectomy: If the inflammation or infection is limited to a single diverticulum, it may be possible to remove the affected portion of the colon through a small incision. This procedure is called a diverticulectomy.
The main benefit of diverticulectomy is that it can effectively treat acute diverticulitis in its early stages, when the inflammation or infection is limited to a single diverticulum. This procedure is typically performed through a small incision, which results in less pain, scarring, and a quicker recovery than a traditional open surgery.
Resection and primary anastomosis: If the inflammation or infection is more widespread and the inflammation or infection has spread to multiple diverticula, a portion of the affected colon may need to be removed. This procedure is called a resection and primary anastomosis. The remaining healthy parts of the colon are then reattached.
The benefit of this procedure is that it can remove the affected tissue and prevent further complications, such as perforation or abscess formation.
Colostomy: In some severe cases of acute diverticulitis, a colostomy may be necessary to protect the patient from life-threatening complications, such as peritonitis. This procedure involves creating an opening (stoma) in the abdominal wall and routing the remaining healthy part of the colon through the opening. Feces are collected in an external bag attached to the stoma.
The main benefit of a colostomy is that it provides a safe and effective way to manage fecal elimination while the affected area of the colon heals.
Hartman's Procedure: FYI, this is kind of what I had (open method); my personal story is at the bottom of this post.
In the event of an emergency surgery, Hartmann's procedure may be performed by your doctor. This involves removing the affected portion of the colon and cleaning out any infected areas in the abdominal cavity. The procedure requires general anesthesia and can be done through laparoscopy or an open method.
If the two ends of the colon cannot be reconnected safely due to the infection, your surgeon will create a stoma - a connection between your bowel and the abdominal wall. This allows the waste to exit your body.
To create the stoma, your surgeon will make an incision in your abdomen and connect a part of the intestine to the opening in the skin. The rectum is temporarily sealed with sutures (mine wasn't), and an odor-resistant colostomy bag is attached to the opening to collect the waste.
During your recovery, the stoma allows your colon to rest and heal as waste exits your body and is collected in the bag.
After a few weeks of healing, typically 2-3 months, your doctor will reconnect the two ends of the colon, close the stoma, and remove the rectum sutures. Your bowels will then return to normal function.
Post-Surgery Expectations: After undergoing Hartmann's procedure, you will be given antibiotics to treat the infection. The duration of antibiotics will depend on your recovery and the severity of the infection.
You may need to stay in the hospital for a few days for monitoring. The pain management specialists and ostomy nurses at your hospital will help you recover and adjust to using the colostomy bag comfortably.
Elective Sigmoidectomy: If you have experienced two to three episodes of diverticulitis, your doctor may suggest an elective procedure called a sigmoidectomy. This procedure involves removing the affected part of the colon, known as the sigmoid colon, to reduce the likelihood of recurrence.
Before making a decision, you and your doctor will discuss the pros and cons of elective surgery. If you opt for the procedure, your doctor will perform minimally invasive colorectal surgery through either traditional laparoscopy or robotic-assisted surgery. Both methods require general anesthesia.
For a laparoscopic sigmoidectomy, the surgeon will make several small incisions in the abdomen and insert laparoscopic instruments. The surgery is performed with the aid of a two-dimensional image displayed on a video monitor.
In the case of robotic-assisted surgery, the surgeon uses a sophisticated surgical system with tiny instruments mounted on robotic arms. The camera arm projects a high-definition, three-dimensional image on a computer monitor, which the surgeon uses as a guide. The instruments and camera are inserted through small incisions, and the surgeon operates the tools and camera from a console.
For both techniques, the abdomen is inflated with gas to expand the cavity and give the surgeon a better view and greater mobility. The sigmoid colon is identified and removed, and the two ends of the diseased portion are joined using anastomosis with a laser. The surgery typically takes three or more hours.
Post-Surgery Expectations: After the elective sigmoidectomy, you can expect to stay in the hospital, usually for two to four days. You will initially be given liquids, and your doctor will monitor your bowel movements. After observation, while recovering in the hospital, you are typically allowed to start eating solid foods and go home. For a month or so after surgery, your doctor will likely recommend avoiding lifting anything heavy, as well as movements or exercises that could strain the abdomen.
It is important to discuss all the above options with your doctor. You should make sure to discuss things like; Possible complications, diet, exercise, and recovery time.
The choice of surgery depends on the severity of the acute diverticulitis and the overall health of the patient, as well as other factors. Your doctor will work with you to determine the best course of treatment based on your specific needs and circumstances.
The benefits of surgery for acute diverticulitis are not the same for all patients. The best course of action will depend on individual factors such as age, overall health, and the severity of the condition. Your doctor can/should discuss the specific benefits and risks of each type of surgery for your case.
I highly suggest avoiding the following for a while after any of the aforementioned surgerys:
Eating large meals - You don't want to stretch/cause pressure that could cause bleeding where surgery was performed.
Avoid anything that could possibly constipate you - Same reason as above.
Here are some helpful links to provide more helpful information:
My story is a little different than most. I originally went to the hospital with a high fever, no pain or diverticulitis, just vomiting. This was around the H1N1 flu time, That's what they thought I had, and sent me home. Two days later, I was still running a high fever and went back to the hospital and was throwing up green bile. After some more testing, they discovered my gallbladder had ruptured. FYI, I never had a gallstone or anything wrong with my gallbladder before. After discovering my gallbladder had ruptured they went ahead and put me in surgery immediately and performed laparoscopic surgery to remove it.
While in recovery, I started going downhill, having very high fever and mild convulsions after a week or two. I had to convince them that something was wrong that first week after the surgery. I was in the hospital this entire time; after a week, they finally realized something was wrong, and it still took them a couple of weeks to figure out what it was. By this time, I was literally on my deathbed.
They told my family and I that my colon had perforated, turns out I was septic those prior weeks. It's a miracle I survived. I don't remember much, as I was heavily sedated on morphine and then Dilaudid. Odd that my colon had preforated right after the laparoscopic surgery...? There might have been a malpractice suit there! They rushed me into surgery once they finally figured out I was septic. My wife was distraught, thinking I was going to die. It was that bad, I remember thinking the same. It was really hard for her to deal with this and taking care of our kids. When they put me under anesthesia, I guess they didn't consider the fact that I had been on Dilaudid for a few weeks. So I woke up during my surgery started ripping everything out of my arms, yelling it hurts, it hurts. About a month or so after getting out of the hospital, I had a follow-up with my surgeon. I asked him if that really happened, as it seemed like a dream. He said, "yep, you freaked everybody out."
At this time, I had been living with diverticulosis/diverticulitis for roughly ten years. I was experiencing three to four cases of acute diverticulitis a year. Lots of CT scans, antibiotics and pain. I could not have elective surgery during these years as I was/am self-employed, and back then, health insurance didn't cover pre-existing conditions/my diverticulosis. I couldn't get health insurance and couldn't afford the surgery as the sole provider for a family of four.
... Back to the surgery, I woke up with a colostomy bag and remember actually crying when the nurse was showing me how to maintain my stoma and use/empty/clean the colostomy bag. I was happy to be alive, but it was in shock, realizing my life could have just ended, being deathly sick for weeks, thinking I was dying, and I was going to have to deal with a colostomy bag for three months. It was a lot to deal with, along with knowing I would have to get cut open again to have my colon put back together didn't help me feel any better. Turns out the section of the colon they removed was the really bad section. The second surgery to put my colon back together went well, and I was SO glad to be getting rid of the colostomy bag! Unfortunately, I still have diverticula present in other parts of my colon, but my flare-ups are a lot less frequent. I believe that is mainly from changing my diet, adding supplements, and not drinking alcohol like a fish.
I wanted to share this story to help people as many people as possible. For those of you debating whether to get elective surgery, I highly suggest doing so, I wish I could have. You don't want to wait until it gets so bad that you must have emergency surgery! Trust me; you want to avoid the colostomy bag and two surgerys if you can. The whole thing seems like a bad dream now, but it was indeed the most difficult time in my life!
I had to go through this surgery while being septic for God knows how long, right after another surgery, being extremely sick, malnourished/living of an IV for weeks, very frail and skinny. If I can make it through that, you can too!! I pray your situation is nothing like mine, good luck to anyone getting surgery, and please know you can and will make it through this!!!
To everyone dealing with acute DV and surgery, my heart truly goes out to you. Just know that you will get through it and come out of this with a better life. After surgery, as long as you change your diet/eating habits, add some supplements, and exercise a little, you can hopefully live a pretty normal life, as I have for the past ten years since this happened.